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Original Investigation
December 2018

Association of Caffeine Intake and Caffeinated Coffee Consumption With Risk of Incident Rosacea in Women

Author Affiliations
  • 1Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao, Shandong, China
  • 2Harvard University, Cambridge, Massachusetts
  • 3Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
  • 4Division of Dermatology, Department of Medicine and Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
  • 5Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
  • 6Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 7School of Public Health, Institute for Chemical Carcinogenesis, Guangzhou Medical University, Guangzhou, Guangdong, China
JAMA Dermatol. 2018;154(12):1394-1400. doi:10.1001/jamadermatol.2018.3301
Key Points

Question  Is there an association between risk of incident rosacea and caffeine intake, including from coffee consumption?

Findings  In this cohort of 82 737 participants in the Nurses’ Health Study II, we identified 4945 incident cases of rosacea, and found a significant inverse association between risk of rosacea and increased caffeine intake, particularly that from coffee. This association was not found for caffeine intake from other food sources (tea, soda, and chocolate).

Meaning  Our findings do not support limiting caffeine intake as a means to prevent rosacea and may have implications for the causes of and clinical approach to rosacea.


Importance  Caffeine is known to decrease vasodilation and have immunosuppressant effects, which may potentially decrease the risk of rosacea. However, the heat from coffee may be a trigger for rosacea flares. The relationship between the risk of rosacea and caffeine intake, including coffee consumption, is poorly understood.

Objective  To determine the association between the risk of incident rosacea and caffeine intake, including coffee consumption.

Design, Setting, and Participants  This cohort study included 82 737 women in the Nurses’ Health Study II (NHS II), a prospective cohort established in 1989, with follow-up conducted biennially between 1991 and 2005. All analysis took place between June 2017 and June 2018.

Exposures  Data on coffee, tea, soda, and chocolate consumption were collected every 4 years during follow-up.

Main Outcomes and Measures  Information on history of clinician-diagnosed rosacea and year of diagnosis was collected in 2005.

Results  A total of 82 737 women responded to the question regarding a diagnosis of rosacea in 2005 in NHS II and were included in the final analysis (mean [SD] age at study entry, 50.5 [4.6] years). During 1 120 051 person-years of follow-up, we identified 4945 incident cases of rosacea. After adjustment for other risk factors, we found an inverse association between increased caffeine intake and risk of rosacea (hazard ratio for the highest quintile of caffeine intake vs the lowest, 0.76; 95% CI, 0.69-0.84; P < .001 for trend). A significant inverse association with risk of rosacea was also observed for caffeinated coffee consumption (HR, 0.77 for those who consumed ≥4 servings/d vs those who consumed <1/mo; 95% CI, 0.69-0.87; P < .001 for trend), but not for decaffeinated coffee (HR, 0.80; 95% CI, 0.56-1.14; P = .39 for trend). Further analyses found that increased caffeine intake from foods other than coffee (tea, soda, and chocolate) was not significantly associated with decreased risk of rosacea.

Conclusions and Relevance  Increased caffeine intake from coffee was inversely associated with the risk of incident rosacea. Our findings do not support limiting caffeine intake as a means to prevent rosacea. Further studies are required to explain the mechanisms of action of these associations, to replicate our findings in other populations, and to explore the relationship of caffeine with different rosacea subtypes.